Epidemiology of cervical cancer: A retrospective study in tertiary health-care center in Kolkata over one decade

ABSTRACT

Background: Globally, cervical cancer is the most common gynecological cancer and the 4th most common malignancy in women with over 526,000 cases diagnosed in 2015 and 239,000 dying of carcinoma cervix every year. Cervical cancer is more common in areas where women have less access to screening, including parts of Asia, Africa, and Central and South America. Cervical cancer is the second most common cancer among women in India and also the second most common cancer among women between 15 and 44 years of age and one of the leading causes of cancer mortality, accounting for 17% of all cancer death among women aged between 30 and 69 years. Nearly, all cases of cervical carcinoma can be attributable to human papillomavirus (HPV), and type 16 and 18 cause 70% of cervical cancer and precancerous cervical lesion worldwide. It is now well-established fact that persistence of HPV infection is a causative factor for cervical neoplasia. Epidemiological data regarding cervical cancer are lacking in India. Objectives: The aim of our study was to evaluate the prevalence and epidemiology of cervical cancer in our institution. Materials and Methods: Newly diagnosed carcinoma cervix cases registered at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India, between January 2009 and December 2018, were analyzed retrospectively. A total of 4082 cases confirmed by histopathological examination included for analysis. Age, parity, age at marriage, residential area, symptoms, stage, and histological types collected from patient’s record file. Staging was done using Federation of Gynecology and Obstetrics staging system. Results: About 92% of patients came from rural areas and rest of the patients came from urban areas. Median age of diagnosis is 48 years. Most patients presented in Stage II and Stage III disease (85%). Squamous cell carcinoma found in 85% of patients and most common histology; adenocarcinoma second most common histology (14%). Lymph node metastasis seen in pelvic nodes (48%) followed by para-aortic node (9%) and supraclavicular metastasis in <1% of patients. The most common sites of distant metastasis seen in lung (19%) followed by bone (14%) most commonly to pelvic bone and lumbar vertebra. Conclusion: Most carcinoma cervix patients presented in Stages II and III and squamous cell carcinoma is the most common histology seen in 85% of patients. HPV related and molecular risk factors are needed further investigation in future. Multi-institutional and longer period of study may represent population-based data. Awareness of our society regarding needs for screening of asymptomatic patients and HPV vaccination initiative from government is needed for the reduction of incidence and death from cervical cancer.